Inter-facility transfers to an urban level 1 trauma center and rates of secondary overtriage.

Abstract

Purpose: Many patients originally transported to non-trauma centers (NTC) require transfer to a trauma center (TC) for treatment. The aim was to analyze injury characteristics and outcomes of transfer patients and investigate the secondary overtriage (SOT).

Methods: Study included 2,056 transfers to an urban level 1 TC between 01/2016 and 06/2020. Analyzed variables included: demographics, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), transfer reason and timing, computed tomography (CT) scans, surgery rate, intensive care unit (ICU) admissions, hospital lengths of stay (HLOS), mortality and SOT. SOT was defined as discharge within 48 h without surgery or ICU admission.

Results: Transfers constituted 32.1% of TC admissions. Mean age was 66.7 and 60.7% were geriatric (≥ 65 years). Mean ISS was 11.6 and GCS was 14.3. The average time between NTC and TC admission was 4.2 h. Main reason for transfer was a head injury (57.9%), followed by a spine injury (19.2%). CT scans were repeated at the TC in 76.1% of patients. Surgical interventions were necessary in 18.5% of patients, with lowest rate in head (13.8%) and spine (15.4%) injuries. 45.9% of patients required ICU admissions. Overall mortality was 7.2%. SOT was 30.5%, being the highest in patients with spine (43.0%) and head (29.4%) injuries. Short HLOS affected SOT rates the most.

Conclusions: Transfers constituted a third of all TC admissions. The main reasons for transfer were head and spine injuries. SOT accounted for one third of transfers and occurred primarily in patients with spine and head injuries.